Psychological Status of Medical Staff in Obstetrics and Gynecology Hospitals during the Omicron Pandemic Outbreak in China

Background Medical staff in China faced great challenges and psychological and physiological changes of varying degrees during the omicron epidemic outbreak. It is important to recognize the potential impact of these challenges on the mental health of medical staff and to provide appropriate resources and support to mitigate their effects. Methods A total of 354 medical staff in two obstetrics and gynecology hospitals of different grades were included in this survey using convenience sampling. The cross-sectional self-report questionnaires survey was conducted using the Basic Characteristics Questionnaire, Generalized Anxiety Disorder (GAD-7), Patient Health Questionnaire (PHQ-9), and Insomnia Severity Index (ISI). Results There were 169 (47.7%) participants suffering from anxiety disorder. Working with fever, working in obstetrics, and working with protective clothing were the risk factors for anxiety in medical staff (p < 0.05). One hundred and ninety-six (55.4%) participants were depressed. Working with fever and working in obstetrics were the risk factors for depression in medical staff (p < 0.05). There were 117 (33.1%) participants suffering from insomnia. Working with fever, high educational level, and severe COVID-19 infection status were the risk factors for insomnia in medical staff (p < 0.05). Moreover, medical staff in a provincial hospital were more anxious and depressed than those in a county hospital. At last, there were more participants working with fever in obstetrics (p < 0.05). Conclusion Anxiety disorder, depression, and insomnia were common among obstetrics and gynecology medical staff during the outbreak of omicron pandemic. During this period, more resources for psychological counselling should be provided to the hospital as well as more reasonable staffing arrangements, and working while having a fever is prohibited, especially in provincial hospital.


Introduction
Coronavirus disease 2019 (COVID- 19) is an emerging infectious disease with the fastest spread, the widest range of infection, and the greatest difculty in prevention and control in the past century.It is unique and persistent and poses a serious threat to human physical and mental health.Te frst case of novel coronavirus pneumonia was discovered in December 2019 in Wuhan, China [1].Over the past three years, China has implemented strict epidemic control measures.On 8 December 2022, the Chinese government issued 10 new epidemic control measures for the novel coronavirus; one of them is "Nucleic acid testing is no longer carried out for the whole population.Except for nursing homes, welfare homes, medical institutions, kindergartners, primary and secondary schools, and other special places, nucleic acid test negative certifcates and health codes are not required."Tis measure triggers the peak of the omicron epidemic outbreak across the country.During this period, medical personnel in China faced great challenges and psychological and physiological changes of varying degrees.Due to staf shortages, many medical staf go to work despite being sick before their symptoms are completely relieved.Family life, high work intensity, increased work pressure, and even facing the death of patients have led to negative physical and psychological efects on medical staf, such as job burnout, anxiety, depression, and insomnia.Previous surveys and studies in other countries and small outbreaks in China have reported that medical staf experienced varying degrees of anxiety, depression, and insomnia during epidemic outbreaks, which deserves attention [2,3].
Te psychological status of medical staf working in obstetrics and gynecology hospitals is a complex and important issue.Te demands of this specialty can be particularly challenging for health professionals, given the emotional intensity of working with women during some of the most vulnerable moments of their lives.Te mental health challenges for medical staf in obstetrics and gynecology hospitals can include [4,5] compassion fatigue and trauma, medical staf may experience emotional exhaustion and a sense of detachment due to constant exposure to traumatic experiences; high-stress situations, medical staf in obstetrics and gynecology hospitals may encounter highstress situations, such as medical emergencies and complications during childbirth; perinatal loss and grief, medical staf may struggle with their own grief and loss when they are unable to save the life of a patient or her unborn child.It is important to recognize the potential impact of these challenges on the mental health of medical staf and to provide appropriate resources and support to mitigate their efects.However, to date, we have not found any survey and analysis of medical staf working in obstetrics and gynecology hospitals of diferent grades in China.
Te aim of this study was to analyze the psychological status of medical staf in obstetrics and gynecology hospitals in China and its infuencing factors during the outbreak of omicron, so as to provide sufcient theoretical and scientifc basis for the formulation and implementation of relevant policies and measures to improve the psychological status of medical staf in obstetrics and gynecology hospitals.

Recruitment.
Te study was conducted through an online survey from January 10 to 31, 2023.A total of 354 respondents were from Women's Hospital, School of Medicine, Zhejiang University (N � 166) (a provincial hospital), and Ninghai Maternal and Child Health Hospital (N � 188) (a county hospital).Tis study was approved by the hospital's ethics committee (IRB-20230166-R).

Questionnaire Design.
To reduce face-to-face communication and avoid infection, potential respondents were invited electronically, and the response rate was approximately 10%.Tey completed the questionnaire anonymously through the online survey platform (Surveystar, Changsha Ranxing Science and Technology, Shanghai, China).Te questionnaire consists of four parts: basic characteristics, Generalized Anxiety Disorder (GAD-7), Patient Health Questionnaire (PHQ-9), and Insomnia Severity Index (ISI).Tis questionnaire was used to assess pregnant women's psychological status between December 8 and 31, 2022.

Statistical
Analysis.Basic characteristics were described as mean ± SD or number (%), and scores of diferent questionnaires were also described as mean ± SD or number (%).Te F-test was used for parameters with nonnormal distributions.Categorical variables were analyzed using the Chi-square test or Fisher's exact test.Logistic regression was used to estimate odds ratios (ORs) and 95% confdence intervals (CIs) for psychological status in the total participants.p < 0.05 was considered statistically signifcant.Data were analyzed using SPSS software 26.0.Moreover, there were more participants working with fever in obstetrics than other departments (Table S1).Te difference is statistically signifcant (p < 0.05).

Te Physiological Status of Medical Staf.
Te physiological status of medical staf is shown in Table 2. Te diference of anxiety disorder and depression between different departments was statistically signifcant, and obstetrics had the most participants with anxiety disorder and depression (p < 0.01, p < 0.001, respectively).Participants working with protective clothing were more anxious than those who did not work with protective clothing (p < 0.01).
Participants who worked with fever were more anxious and depressive than those who did not work with fever (p < 0.05, p < 0.01, respectively).Table 2 shows that participants who worked with fever were more likely to sufer from insomnia than those who did not work with fever, and the diference is statistically signifcant (p < 0.05).Tere were no signifcant diferences in the other categories (Table S2, Table S3, and Table S4).

Association between Basic Characteristics and Psychological Status.
Tables 3 and 4 show that working with fever, working in obstetrics, and wearing protective clothing were the risk factors for anxiety disorders among medical staf.
Working with fever and working in obstetrics were the risk factors for depression.In addition, working with fever, high educational level, and severe COVID-19 infection status were the risk factors for insomnia among medical staf.Te diference is statistically signifcant (p < 0.05).

Te Comparison of Two Hospitals of Diferent Grades.
As shown in Table 5, medical staf working at Women's Hospital, School of Medicine, Zhejiang University, were more anxious and depressed than those who working at Ninghai Maternal and Child Health Hospital (p < 0.05).Te working hours of the former were signifcantly longer than those of the latter (p < 0.01).

Discussion
Psychological distress and sleep problems are important public health issues when epidemics and disasters occur, and these efects can be long lasting.So, we used the form of questionnaire (which includes basic characteristics, GAD-7, PHQ-9, and ISI) to assess the psychological status of medical staf.Te current study fnds that obstetrics medical staf were more likely to be anxious and depressed and more of them came to work with fever; medical staf who have higher levels of education and who have a severe COVID-19 infection were also more likely to have insomnia; and those who wear protective clothing were more likely to have anxiety disorder.Besides, medical staf of a provincial hospital were more anxious and depressed than those in a county hospital.Moreover, some factors, such as gender,    [2], conducted in China from January 29 to February 3, 2020, reported experiencing distress, with 50% reporting depressed and 34% citing insomnia.Participants from outside Hubei province had a lower likelihood of exhibiting symptoms of distress than those from Wuhan, according to a multivariable logistic regression study.In December 2022, the virus spread throughout all of China at a rate comparable to Wuhan at the time.
Tere was no discernible variation in psychological status amongst medical staf members of diferent genders, contrary to earlier reports [11].Tis could be for several reasons, including the fact that all medical staf must deal with the same level of responsibility and workload because of the nature and responsibilities of working in obstetrics and gynecology hospitals.In dealing with patients' ailments and pain, medical workers must carry a same emotional load regardless of gender.Male and female medical professionals at obstetrics and gynecology facilities have similar professional demands and challenges, such as long working hours, hectic schedules, ongoing technology advancements, and frequently shifting medical policies.Obstetrics and gynecology hospitals are typically highly specialized medical institutions, and medical staf are required to have the same professional knowledge and skills.Tis may lead to a narrowing of gender diferences in medical expertise.In summary, even though male and female medical staf in obstetrics and gynecology facilities may have distinct working and personal experiences, their job obligations and work demands are comparable; therefore, their levels of anxiety and depression may be fairly balanced.
In this study, working with fever made medical staf more anxious and depressed and sleep deprived.It was hypothesized that having fever and reporting to work could be harmful to the mental health of medical staf.Increased burnout, job stress, and emotional exhaustion are a few of the potential causes.Healthcare organizations should put their employees' health and wellbeing frst by advising unwell personnel to stay at home and provide enough assistance and resources to stop burnout and other harmful efects.
Te medical professionals in the obstetrics feld reported greater incidence of anxiety and depression.Also, a disproportionately greater percentage of medical staf in obstetrics arrive at work with a fever.During the pandemic  Canadian Journal of Infectious Diseases and Medical Microbiology outbreak, people avoided leaving their homes until absolutely necessary, postponed elective surgeries, and did not seek nonemergency medical attention.During the outbreak, hospitals stopped elective procedures, except in the obstetrics department.Outpatient visits were less than usual.As a result, there were much fewer patients than normal in the gynecological and outpatient clinics.Due to the fact that childbearing is a basic human requirement and pregnancy and childbirth are unavoidable natural processes, the number of obstetric patients will not diminish during the pandemic.Te majority of women still require medical services, such as preconception check-ups, pregnancy checkups and childbirth, even during the epidemic.Also, while the majority of women opt to take antipyretic medications on their own after contracting COVID-19, pregnant women may decide to seek medical attention out of concern for the wellbeing of the fetus.As a result, many women may require more obstetric care to maintain their health and the health of their unborn children.Due to a lack of staf, the obstetric medical staf must report to work when sick.Tis phenomenon demonstrates the need to fairly adjust each department's employment in light of the epidemic condition.
Although the relationship is complicated and not fully understood, the current fnding revealed that there may be a positive association between educational attainment and depression.On the one hand, those with more education typically earn more money, have better employment possibilities, and have access to more tools that can help them deal with stress and other issues in life.Better mental health outcomes and lower incidence of depression may result from this [12,13].Higher levels of education, however, can also be accompanied with a variety of pressures and difculties, including heightened academic pressure, fnancial strain, and competition for employment possibilities.Increased rates of depression can be brought on by these pressures, particularly in those who may already be predisposed to mental health issues.Overall, the relationship is complex and probably infuenced by a number of factors, including personal characteristics, socioeconomic status, and life experiences [14].Tere is some evidence to support a positive association between educational attainment and depression.
Te degree of education may be positively correlated with insomnia.Also, one explanation for the correlation could be that those with higher levels of education work harder or longer hours, which results in higher levels of stress and trouble unwinding at night.More educated people might also be more prone to partake in activities that interfere with sleep, such as utilizing electronics right before bed.Te study demonstrates a negative correlation between utilizing electronic devices before bed and the quality of your sleep [15][16][17].More educated medical professionals also have more job obligations.A considerable drop in the number of employees working on the job was caused by the large number of medical professionals who, particularly during the pandemic, took sick leave at home owing to infection.Worries over the general state of the job caused leaders to have insomnia.
Evidently, insomnia is correlated to the severity of COVID-19 infection.It makes sense that these people might experience worse respiratory or fever symptoms, as well as a lengthier illness course, which would have an impact on their quality of sleep.Moreover, according to several studies [18][19][20][21], sleep disturbance was the most common neuropsychiatric symptom, and more sleeplessness was linked to a more serious COVID-19 infection.
Previous studies [22][23][24][25] suggested that medical staf had anxiety, depression, and even posttraumatic stress disorder (PTSD) after the epidemic outbreak, and few participants had received psychological interventions and fewer participants had received individual interventions.Tis shows that current psychological interventions were not sufcient, and target psychological interventions should be conducted in time.
In the current study, we compared the mental health of medical staf between two hospitals of diferent grades, which is the highlight of this article.According to data analysis, medical staf working at Women's Hospital, School of Medicine, Zhejiang University, had higher GAD-7 and PHQ-9 scores than those working at Ninghai Maternal and Child Health Hospital.We could take into account elements like difering working hours, variations in stafng numbers, resources, or patient demographics that would be responsible for these observed discrepancies.Medical staf in provincial hospitals face greater job demands, occupational risk, and social pressure than county hospitals, which could contribute to higher levels of anxiety and depression.A survey found that there is a general shortage of medical staf in tertiary hospitals [26].In particular, in high-stress work environments, such as tertiary hospitals, it is crucial for healthcare companies to ofer support and resources to promote the mental health and wellbeing of their staf.
As far as we are aware, this study is the frst of its kind to concentrate on the mental health of medical personnel working in obstetrics and gynecology hospitals during the most recent national COVID-19 pandemic.Also, it is the frst-time the hospitals for obstetrics and gynecology of various levels have been compared.
Te following limitations must be noted.First, given the study's cross-sectional design, we can only assert association rather than causality, and we hope to be able to follow up the psychological status of medical staf, which is also our future research direction.Second, we have control for some potential confounding factors, such as age and educational level; however, it is really difcult to control demographic characteristics, personality traits, coping styles, social support, and other sources of stress, which may infuence the psychological status of the medical staf.Also, because only 354 participants were sampled, there may not be much generalizability.Te participants may have been the most afected or those most eager to assist because the responses were voluntary.Tere is the possibility of a representation bias.Tis is also a general limitation of questionnaire survey.

Conclusion
In summary, the psychological status of medical staf working in obstetrics and gynecology hospitals is a critical issue that requires attention and support from healthcare 6 Canadian Journal of Infectious Diseases and Medical Microbiology organizations and policymakers.Anxiety disorder, depression, and insomnia are common among medical staf during the outbreak of omicron pandemic in China.More resources for psychological counselling should be provided to the hospital during this time, as well as more reasonable stafng arrangements and a prohibition on working when feverish, especially in Grade A tertiary care facilities.
cOther department: administrative departments, logistics departments, and medical technology auxiliary departments.dSituations require wearing protective clothing: transporting persons of cases and asymptomatic infected persons; environmental cleaning and disinfection personnel; specimen collection personnel; laboratory staf; the staf who conducted epidemiological investigation of suspected, confrmed cases and asymptomatic infection cases; isolation of staf in wards and medical observation places.Canadian Journal of Infectious Diseases and Medical Microbiology

Table 3 :
Association between basic characteristics and psychological status.

Table 4 :
Risk factors for physiological status identifed by multivariable logistic regression analysis.
*Logistic regression was used to estimate odds ratio (OR) and 95% confdence interval (CI).a Adjusted for working with fever, department, and protecting wearing; b adjusted for working with fever and department; c adjusted for working with fever, educational level, and COVID-19 infection status; NA: not applicable; * p < 0.05; * * p < 0.01.

Table 5 :
Te comparison of two hospitals of diferent grades.Te F-test was used for parameters with nonnormal distributions.Data are reported as mean ± SD.Group 1: Women's Hospital, School of Medicine, Zhejiang University; Group 2: Ninghai Maternal and Child Health Hospital.